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2025 Annual Meeting Registration
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Name
*
First
Last
Guest name(s), if applicable
Email
*
Cell number
City of practice, if applicable
Primary specialty, if applicable
Copic insured?
Yes – I am Copic insured
No – I have medical liability insurance through another carrier
Not applicable/not in need of Copic Points
Expected attendance at meals
Friday evening Welcome Reception
Saturday morning breakfast buffet
Saturday COMPAC lunch
Saturday evening Presidential Gala
Dietary preferences or allergies for anyone in your party:
Mobility accommodations needed for anyone in your party to fully participate in this event? (e.g., wheelchair accessibility, seating needs, elevator access):
If utilizing free childcare: Child(ren) ages:
Childcare sessions I will utilize:
Saturday morning 8 a.m.-12 p.m.
Saturday evening 4 p.m-8 p.m.
If participating in the Research Poster Competition: Category
Evidence-based review
Primary research
Case report
Researcher name(s), primary contact listed first
Poster title and brief abstract
Comments or questions
Registration type (select all for your party)
*
Physician member of CMS –
$200.00
Physician non-member –
$400.00
Guest (adult) –
$75.00
Guest (child/ren) –
$0.00
Medical student or resident/fellow –
$25.00
Component society executive –
$200.00
Total
Order Summary
Item
Quantity
Qty
Total
There are no products selected.
Registration type (select all for your party) – Physician member of CMS
1
$200.00
Registration type (select all for your party) – Physician non-member
1
$400.00
Registration type (select all for your party) – Guest (adult)
1
$75.00
Registration type (select all for your party) – Guest (child/ren)
1
$0.00
Registration type (select all for your party) – Medical student or resident/fellow
1
$25.00
Registration type (select all for your party) – Component society executive
1
$200.00
Subtotal
Total
$0.00
$0.00
Stripe Credit Card
*
Submit
